Overview
Bladder cancer is the second most common urologic cancer after prostate cancer
accounting for approximately 54,000 cases per year.
Causes:
The actual causes of bladder cancer are unknown although it is associated with exposure
to tobacco and certain chemicals.
Risk Factors and Warning Signs
The risk of developing bladder cancer is greater for individuals who have:
Tobacco Use: According to the American Cancer Society, smoking is responsible for
approximately 47 percent of bladder cancer deaths among men and 37 percent among
women
Industrial Chemicals and Dyes Exposure
The most common warning sign of bladder cancer is blood in the urine (hematuria),
which does not necessarily change the color of the urine as it is very often microscopic
(not visible to the naked eye). Other symptoms may include:
Change in bladder habits, including having to urinate more often:
Difficulty initiating or stopping urine flow
Weak or interrupted urine flow
Painful urination
Early Detection and Screening
Screening tests (which are also used diagnostically) may include:
Urine Cytology: In this test, the urine is examined under a microscope to look for any
cancerous or precancerous cells.
Cystoscopy: Using a cystoscope - an instrument consisting of a slender tube with a lens
and light that is placed into the bladder through the urethra - the physician can check the
bladder and urethra for possible cancers. Suspicious tissue can be removed during this
procedure so that they may be checked under a microscopic for signs of cancer.
DiagnosisSuperficial Bladder CancerInvasive bladder cancer (into the wall)
If bladder cancer is suspected, there are several methods to confirm the diagnosis as well as to determine the stage
(spread) of the disease. Staging of the bladder cancer is necessary to determine the most effective therapy. This
takes into account the size of the tumor, the extent of disease as to whether it has metastasized or spread to other
organs. In Stage 0, the tumor cells remain confined within the bladder and have not invaded the muscle or
connective tissue of the bladder wall. Stage I disease means the cancer has spread to the layer of connective or
supporting tissue under the lining layer of the bladder, but it has not spread to the thick layer of muscle in the
bladder wall, the lymph nodes or to any other organs. In Stage II disease, the tumor has invaded the thick muscle
layer of the bladder wall, but has not reached the fatty tissue that surrounds the bladder or beyond. Stage III and IV
indicate more serious disease with invasion of the cancer into nearby organs, such as the prostate, uterus or vagina,
or in Stage IV, to the lymph nodes and more distant organs, such as bones, liver or lungs. The lower the number of
the stage, the less the cancer has spread. To make the diagnosis and to assess the extent of the tumor the following
are often necessary:
Biopsy: Suspicious tissue can be removed during a cystoscope procedure so that it can be analyzed under a
microscopic for signs of cancer.
CT Scan: If it is suspected that bladder cancer has spread, a CT scan of the pelvis provides information about the
extent to which it has spread.
MRI Scan: Like the CT scan, an MRI may be recommended to determine if cancer has spread beyond the bladder
into adjacent tissues, nearby lymph nodes or to distant organs.
Treatment
Surgery
TRANSURETHRAL SURGERY: This procedure is indicated for bladder cancer in the early stages. It is performed
through a cystoscope like instrument to scrape out the tumor within the bladder when it has not penetrated the bladder
wall. Since there is a propensity for reccurrence, close follow-up treatment is indicated to ensure early detection of
future cancers.
CYSTECTOMY: For cancer that is more invasive, a cystectomy may be indicated in which part of the bladder (partial
cystectomy) or the entire bladder and nearby lymph nodes and adjacent organs (radical or total cystectomy) may be
indicated.
RECONSTRUCTIVE SURGERY: If the bladder needs to be removed, reconstructive surgery can be performed to
create an alternative for storage and removal of urine. Please see “Urinary Diversion” as listed on the home page.
Radiation Therapy
Radiation therapy is usually advised to eliminate any remaining abnormal cells following transurethral surgery. The
treatment uses high-energy rays that are applied externally or small pellets of radioactive material placed directly into
the cancer. Radiation therapy may also be used to shrink the tumor prior to surgery to make the procedure easier.
External beam radiation therapy administered in conjunction with chemotherapy following local removal of a bladder
tumor can allow for bladder preservation without compromising loco-regional tumor control.
Immunotherapy
In this treatment, an immunotherapeutic agent (BCG) is delivered directly to the bladder (intravesical) through a
catheter to treat low-stage bladder cancer.
Chemotherapy
Chemotherapy uses drugs to destroy cancer cells and is an important treatment for bladder cancer and can be delivered
directly into the bladder (intravesical), by mouth or via injection. When given directly into the bladder, the
chemotherapy will not reach cancer cells that have invaded the bladder wall or spread to other organs. Therefore this
treatment is used for only non-invasive or minimally invasive bladder cancer. For more advanced disease,
chemotherapy should be given by mouth or by injection so that it can reach cancer cells that have spread beyond the
bladder to lymph nodes and other organs.
Prevention
It is recommended to abstain from smoking - a significant risk factor for developing this
disease, and to use appropriate precautions to limit occupational exposure to certain dyes
(particularly aniline dyes), rubber and leather, which have been shown to increase the risk
of bladder cancer.